Healthcare Provider Details

I. General information

NPI: 1528797917
Provider Name (Legal Business Name): PAMELA LYN HUTTON FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2022
Last Update Date: 10/16/2023
Certification Date: 10/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1188 YADKINVILLE RD
MOCKSVILLE NC
27028-2037
US

IV. Provider business mailing address

100 KIMEL FOREST DR
WINSTON SALEM NC
27103-6074
US

V. Phone/Fax

Practice location:
  • Phone: 336-716-7435
  • Fax:
Mailing address:
  • Phone: 336-713-0947
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF06220147
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: